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The effectiveness of negative pressure wound therapy as a novel management of diabetic foot ulcers: an overview of systematic reviews

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Abstract

Background

Diabetic foot ulcer (DFU) is one the serious disabling conditions in patients with diabetes. Several approaches are available to manage DFU including Negative Pressure Wound Therapy (NPWT). The objective of this overview is systematically reviewing the related reviews about the effectiveness, safety, and cost benefits of NPWT interventions.

Methods

In October 2018, electronic databases including Medline, Embase, Scopous, Web of Science, the Cochrane Library and Google scholar were searched for systematic reviews about the NPWT’s effectiveness and safety in DFUs. The Assessment of Multiple Systematic Reviews 2 (AMSTAR2) checklist was used for the appraisal of the systematic reviews. According to this checklist the studies were categorized as high, moderate, low and critically low quality.

Results

The electronic searches yielded 6889 studies. After excluding duplicates and those not fellfield the inclusion criteria, 23 systematic reviews were considered. The sample size of the reviews ranged between 20 and 2800 patients published since 2004 to 2018. Twenty systematic reviews (86.95%) included only randomized clinical trials (RCT). Regarding the AMSTAR-2 checklist, 7 studies were assigned to high quality, 8 were categorized as low quality and 8 studies belonged to the critically low quality groups. Accordingly, three, two and one out of seven high quality studies approved the effectiveness, safety and cost benefit of the NPWT therapy, respectively. However, some of them declared that there is some flaws in RCTs designing.

Conclusion

This overview illustrated that either systematic reviews or the included RCTs had wide variety of quality and heterogeneity in order to provide high level of evidence. Hence, well-designed RCTs as well as meta-analysis are required to shade the light on different aspects of NPWT.

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Acknowledgements

The authors would like to thank Tricco, A. C et al. [39] and Anaya, M.M et al. [40] in terms of their valuable articles which guided us for preparing Fig. 2 and Table 4 of the study.

Funding

This study was funded by the Endocrinology and Metabolism Research Institute affiliated to Tehran University of Medical Sciences Grant ≠ 1394–03–108-1996.

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Correspondence to Mahnaz Sanjari or Mohamad Reza Amini.

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Mohseni, S., Aalaa, M., Atlasi, R. et al. The effectiveness of negative pressure wound therapy as a novel management of diabetic foot ulcers: an overview of systematic reviews. J Diabetes Metab Disord 18, 625–641 (2019). https://doi.org/10.1007/s40200-019-00447-6

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